Washington State adopts rule to protect healthcare workers from hazardous medications

Washington State becomes the first in the nation to adopt specific workplace safety rules to protect healthcare workers who are potentially exposed to anti-neoplastic drugs and other hazardous medications. The new rule, issued earlier this month by the State's Department of Labor & Industries, stems from legislation passed in April 2011 and signed into law by Governor Chris Gregoire. The rule applies to healthcare facilities in which employees are "reasonably anticipated" to have "occupational exposure to one or more hazardous drugs." The CDC's National Institute for Occupational Safety and Health (NIOSH) published a list of about 150 agents that meet their hazardous drug definition. This list, which is referenced in the new Washington State rule, includes well-known chemotherapeutic drugs such as cisplatin, fluorouracil (5FU), methotrexate, etoposide, temozolomide, and dacarbazine. NIOSH estimates that about 5.5 million healthcare workers----from nurses and pharmacists to housekeepers and veterninary care staff---are potentially exposed to these hazardous agents.

Under the rule, which will take affect beginning in 2014, healthcare facilities with employees who are reasonably anticipated to have exposure to hazardous drugs will be required to develop a "hazardous drugs control program." Components of the program include a written inventory of hazardous drugs in the workplace; a hazard assessment; and policies and procedures such as engineering controls (e.g., biological safety cabinets, laboratory fume hoods,) safe handling practices, personal protective equipment (e.g., chemotherapy gloves,) spill control and waste handling.

Journalist Carol Smith of Investigate West brought this issue to life in July 2010 in her reporting "Lifesaving Drugs, Deadly Consequences." She introduced us to pharmacist Sue Crump, 55 and her 21-year old daughter Chelsea during the mother's experience with pancreas cancer. Smith wrote:

"Sue Crump followed an older cousin into the pharmacy profession. It suited her. She was meticulous, independent, and good with math. She liked being part of a helping profession, and enjoyed her occasional contact with patients. Mostly, though, she was a mixer. ...Most of the chemo came in vials, and they would transfer it into plastic IV bags. Sometimes there would be spray when they punctured the vials. Other drugs came in ampoules, small, sealed glass vessels ready for a single infusion. 'I'd file the neck of it, then snap real fast. A lot of times, I got cuts."

Sue Crump succumb to the cancer in September 2009.

Smith's reporting described how healthcare workers' exposure to chemotherapeutic agents is projected to swell in the years ahead as the US population ages.

"More people will be required to prepare and deliver their treatment. And more of those people will likely be in non-hospital settings such as outpatient clinics, or private homes. 'Home health is a mess,' said Melissa McDiarmid, MD, MPH, a professor at the University of Maryland School of Medicine. 'Drugs are mixed at home health pharmacies and put in zip lock bags and sent off to the home. Where the wheels come off is in the home itself - there are no regulations about where to dump bedpans or trash.'"

In addition, chemo drugs themselves have found wider application - in the treatment of arthritis, multiple sclerosis and other diseases - which puts them in a wider array of physicians' offices. And veterinarians are now increasingly using these drugs to treat animals, putting those who work in vet's offices in contact with chemo."

A key sponsor of the Washington State bill that led to the new regulation was Senator Jeanne Kohl-Welles. She told Investigate West's Carol Smith,

"It is unacceptable that health-care workers risk exposure to deadly chemicals on a daily basis while on the job. This measure could literally save lives by requiring the development of workplace safety standards for these professionals."

The new Washington State workplace safety rule is designed to protect pharmacists and pharmacy technicians, physicians and physician assistants, nurses and patient care assistants, home health care workers, veterinarians and vet techs, housekeeping, laundry, and waste disposal staff in health care facilities, and employees in health care facilities who ship, or receive hazardous drugs from the manufacturer or distributor.

Federal OSHA does not have a specific regulations to address this hazard. The topic was examined in 1994-1995 as part of a comprehensive priority planning process, but the agency decided at the time not to initiate rulemaking. In April 2011, about the same time the Washington State legislature was passing the bill to address healthcare workers' exposure to hazardous medications, OSHA, NIOSH and the accrediting organization The Joint Commission sent a letter to thousands of health care organizations reminding them of this workplace hazard.